This document provides an overview of the mental status examination, a key part of psychiatric evaluation. It describes that the mental status exam involves direct observation of the patient to assess symptoms that are important for diagnosis. It outlines several areas that should be observed, including appearance, behavior, speech, thought processes, thought content, perceptions, mood and affect, insight and judgment, and cognitive functioning. For each area, it provides details on what to look for and definitions of important clinical terms. The mental status exam is important as psychiatric diagnoses are based largely on observations of the patient.

1. The Mental Status
Examination
A Primer for Small Groups, 2009
Rob Averbuch, MD, PhD, CD4, MP3,
MPG2, DVD, RnR, GHFC

2. What is the Mental Status
Examination?
• Sum total of observations made during
a psychiatric interview via:
– Direct Inquiry about subjective symptoms
– Objective findings (signs)

3. Why is it the Mental Status
Exam so Important?
• Almost all psychiatric diagnoses are
made, at least in part, clinically
– i.e. from taking a history, making
observations during the interview, etc.
– Not solely from laboratory values, virology
reports, or imaging studies
– Thus, greater emphasis on direct
observations of patient

4. Mental Status Examination
• Can be divided into 2 sections:
– 1. Observational Data
• Most areas assessed while taking a
history
– 2. Formal Cognitive Testing: MMSE
(Mini-Mental State Exam), etc.

5. What You’ll Want to Observe:
• Appearance
• Behavior
– Cooperation/ Attitude
• Speech
• Thought Process/Form
• Thought Content

6. What You’ll Want to Observe:
• Perceptions
• Mood and Affect
• Insight and Judgment
• Cognitive Functioning and Sensorium

7. Appearance
• Attire
• Hygiene and Grooming
– “Disheveled”- ruffled appearance
– “Unkempt”- poor attention to grooming

8. Appearance
• Body habitus, nourishment status
– General description of body type/ build, and
nutritional status

9. Behavior- Movements
• Range and Frequency of Spontaneous
Movements
– Psychomotor activity
– Abnormal movements

10. Psychomotor Activity
• Psychomotor refers to
movements that appear driven
from within, by one’s internal
emotions at the time
– Psychomotor Agitation, vs.
– Psychomotor Retardation

11. Psychomotor Agitation
defined
• Physical restlessness, usually with a
heightened sense of tension and
increased arousal
• Results from emotions such as anxiety,
anger, and confusion
• Common Signs include: hand-wringing,
fidgeting, frequent shifts in posture, foot-
tapping

12. Psychomotor Retardation
• An overall slowness of voluntary and
involuntary movements
– Results from emotions such as apathy,
depression, etc.

13. Abnormal Movements
• Mannerisms: goal-directed,
complex behaviors carried out in
an odd way or inappropriate
context

14. Abnormal Movements
• Tardive Dyskinesia (TD)- involuntary
choreoathetoid movements of delayed
onset, resulting from long-term
antipsychotic use
• Primarily seen in peri-oral region:
mouth, lips, tongue, face

15. Disorganized Behavior
• Seemingly purposeless, random, non-
goal directed, often complex behaviors
(may include mannerisms)
– Ex. Disrobing in public, urinating on
oneself, dancing, posturing, etc.

16. Cooperation/ Attitude
• Attitude/Relatedness
• Eye contact
• Level of Alertness/ Attentiveness
– Easily distracted
– Hypervigilant (constantly scanning the
environment)

17. Qualities of Speech
• Quantity/Amount
– Too much
– Too little
– None = mutism (absence of speech)

18. Qualities of Speech
• Articulation- clarity with which words
are spoken
– dysarthric (poorly articulated speech)

19. Qualities of Speech
• Rate
– Slowed/halting vs. Normal vs. Rapid

20. Speech Rate
• “Pressured”: increased rate (and
amount); driven to keep talking;
uninterruptible

21. Disorganized Speech
• Speech that is lacking in meaning
and/or inappropriate for the context
• Usually reflective of an underlying
“disorganized thought process”

22. Prosody
• The emotional valence/intonations of
speech; adds emphasis, maintains
listener’s interest
• Speech lacking in Prosody is monotone
and boring

23. Thought Process/ Form

24. Thought Process/ Form
• How ideas are put together, organized,
and ultimately produced (as speech)
• Assessed via speech, writing, and
behavior

25. Normal Variants or
Pathological?
• Circumstantiality- overly detailed;
over-inclusive; but eventually gets to the
point
• Tangentiality- starts out in general
vicinity of goal /target, but never
reaches the end point

26. Abnormalities: Idiosyncracies
• Idiosyncracies: Private use of words,
language; illogical; understanding is
unique to the patient; irrational

27. Abnormal Thought
Processes: Flight of Ideas
• Ideas are linked by primitive
associations such as rhyming, and
punning
• Has a rapid quality
• Often with a sensation of “racing
thoughts”

28. Looseness of Associations
• Looseness of Associations- Ideas
only obliquely related, if at all
• In its extreme form there is a loss of any
meaningful connections between ideas
and it’s unclear how someone decides
to go from one topic to the next

29. Thought Content

30. Thought Content (TC)
• Refers to predominant themes,
preoccupations the person has
• For our purposes, it’s usually about
making sure they don’t have abnormal
thoughts

31. Normal vs. Abnormal TC
• Normal = absence of abnormalities
• Abnormal:
– Delusions
– Obsessions
– Suicidal /Homicidal Ideations

32. What’s a Delusion?
• Fixed false (untrue) belief, not
culturally sanctioned (not just unique,
but accepted in that person’s culture)
– “Fixed” means they’re 100% convinced it’s
true- ie, good luck trying to convince them
otherwise
• Range from implausible (unlikely but
non-bizarre) to impossible (bizarre)

33. Perceptual Abnormalities
• Illusions
• Hallucinations

34. Illusions
• Misperceptions of external stimuli
– There’s something there, but the person is
misinterpreting it as something else
– Ex. a chair may look like a person to
someone who is delirious

35. Hallucinations
• False sensations in the absence of
external stimuli (ie. Anything real)

36. Mood and Affect
How they describe emotional
state vs. what you see

37. Mood
• Mood: internal feeling state
– It’s subjective
– Ex. “happy”, “angry”, “nervous”, “fine”

38. Affect
• Observable, external expression of
emotional tone
– It’s objective

39. Insight and Judgment
• Insight- understanding and
appreciation of current situation, illness
• Judgment- ability to make sound
decisions; best assessed via recent
history

40. The End